It’s been a rough ride for primary health care providers in New Zealand over the past few months to say the very least. At the beginning of lockdown in late March, they had just two days to transform their practices. Most went from delivering nearly 100% of their consultations in person, to delivering around 75% of these online.
A new way of operating that works for everyone?
Some silver linings have emerged from this crisis.
Every practitioner I’ve spoken with has said that during the very first week of conducting online consultations, they quickly realised that they should have made these changes years ago, and that they envisaged that the way they will work in the future will change for the better.
Primary care practitioners, like other professionals, now have a prime opportunity to reduce operating costs and increase margins by minimising the level of investment they currently make in infrastructure – a significant outgoing for most practices. Traditional bricks and mortar surgeries can be consolidated into shared premises for practitioners that can deliver a mix of in person appointments and online consultations. Consolidated practices will also increase the number of registered patients per practice.
With lower total costs, funding might go further.
The biggest difference will be in the ongoing acceptance and availability of online consults. We know that this will be taken up readily by many Kiwis – there’s a huge convenience factor. By staying home, seeing the doctor online and potentially having a contactless prescription delivered, we could help to reduce the spread of colds, flu, and of course the Coronavirus.
Some offshore labour could potentially be utilised, for instance in triaging, to bring down the cost of labour.
New and innovative ways of operating could also be a positive change for future practice owners. At present, we have an ageing demographic of practitioners and a shortage of people willing to buy their practices so they can retire. A new model of working may attract young doctors into practice ownership.
Missed opportunities by Government
Budget 2020 woefully lacked support for the primary healthcare sector; the Government failed to take advantage of the rapid progress practitioners made in terms of digital telehealth and didn’t appear to provide any incentives to enhance the gains already made in this area.
Without more support, some primary healthcare practices will be forced to close; many are just weeks away from completely running out of cash. A survey of 50 general practices throughout the Auckland region conducted by ProCare reveals that 48 are trading at a loss. The survey was carried out during lockdown level 4 and the results prompted General Practice New Zealand Chair Jeff Lowe to ask Health Minister David Clark for urgent additional funding.
We know from experience that when a GP practice closes, it rarely reopens. That service is lost to the local community and health tends to suffer as a result, contributing to the kind of healthcare inequality that we all want to avoid.
Now that we have entered alert level 1, GPs are almost certainly going to experience a massive influx of patients – a tsunami is the word some commentators have used.
Pent-up demand for medical treatment is not the same as the demand we have for other products and services. There is no bake-your-own bread equivalent for health diagnostics. For instance, it’s estimated that every month in New Zealand over 1,000 cancers are detected in routine screening tests. You can defer the testing, but the cancer will still be there. And that’s only one example; anyone who has been avoiding the doctor may have had their condition worsen during lockdown and all those people will now be converging on their local GP practice.
These patients will undoubtedly cause a bottleneck in the public health system along with those who have to cancel their health insurance after a job loss or business downturn.
All this after locums have had their hours reduced, or in many cases they’ve had their allocated sessions cancelled entirely. Those who have found work in other sectors will not be available if an upsurge in patients occurs. We may have lost them from the sector for good.
Supporting the sector that’s on the front line
The primary health care sector could see positive changes in the long run, but practices need immediate treatment for their cashflow shortages. While there are lots of opportunities for practitioners to consider, COVID-19 still ripped the band-aid off the financial challenges they have always faced.
We locked down the nation to save lives and ease the burden on our public health system, now it’s time to lock in some serious cash for a sector that’s on the front lines of this crisis.